Orthopedic Manual Physical
Therapy (AAOMPT) Conference in Biloxi MS. Among the
many fine presentations I
heard, Lance Twomey's ranks among the best. A highlight of
his
presentation was a summary
he gave of a student's doctoral thesis on the independent
benifit of a cervical collar
for recent whiplash patients. The student's name was
Gurumoorthy and his thesis
earned him a Ph.D. and will be published soon in Spine.
However, the information is
so useful and for most therapists so radical that I thought
that
it would be appropriate to
summarise Dr. Twomey's summary. I apologise in advance for
any errors that I may make,
they are inadvertent and caused by galloping senility.
220 post whiplash victims
were randomly divided into three groups the first being
asked
to wear a Philadelphia
cervical collar for one month and then to discard it. These
subjects
were then put into group
two. Group two subjects were assigned an active program
from
day 1 which consisted on
non-painful range of motion and other painfree exercises.
Group
3 were left to the care of
their physician (almost invariably a general practitioner)
who
usually prescribed
analgesics, a soft collar and some form of self activation. The
accident
had to be within forty eight
hours of attendence for the patient to be included as a
subject.
The subjects were tested by
blinded assessors for pain, range of motion, strength and
function. Pain was evaluated
on a visual analogue scale, isometric strength by
dynamometer, range of motion
by goniometry and funtion by return to work. The subjects
were evaluated at 4,6, 12,
26 and 52 weeks.
In every category, the
collared subjects did better than those in the other two
groups.
Perhaps one the most clear
cut findings was in return to function. 50% of the subjects
in
the collared group were back
at full function by the 26th week assessment. This figure
was not achieved in either
of the other two groups.
This is almost unequivocal
evidence of the value of a collar in the early stages of
post-whiplash. The most
amazing thing about the study is that it should have had to
be
carried out in the first
place except as a means of confirming an established and
obvious
practice. With even a little
thought is is obvious that an acutely injured neck requires
the
same care as an acute knee
injury. That is rest while the inflammation subsides. In
the
knee patient we would have
no trouble understanding the need to have the patient
non-weight bearing, using a
compression bandage, applying ice and generally resting
it.
But in the whiplash patient,
there seems to be a lack of common sense by many health
care providers from all
disciplines. The sports medicine model is often applied
indiscriminately with no
thought to the fact that it is not an athlete that we are treating
nor
is it a sport injury. In any
event, an athlete with an acute knee would be rested until
the
effusion had subsided and if
this did not occur in a timely fashion, considerable
expense
and time would be spent
investigating the reason for delayed recovery. If we (the
combined health care
professions) can be this concered about what is essenially
a
self-inflicted injury, why
cannot we be so with some poor soul hit in the rear sitting at
a
traffic light. " Jim Meadows -Manual Therapy Online